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Background The impressive correlation between cardiovascular disease and glucose metabolism alterations has raised the likelihood that atherosclerosis and type 2 diabetes may share common antecedents. Inflammation is emerging as a conceivable etiologic mechanism for both. Interleukins are regulatory proteins with ability to accelerate or inhibit inflammatory processes.

The peer-reviewed monograph summarizes the results of many years of research by the head of the endocrinology department of the Lviv Medical Institute prof. Ya. I. Tomashevsky and his staff dedicated to the early diagnosis of diabetes mellitus (DM) using pyruvaturic, pyruvatemic and pyruvate dehydrogenase tests. The significance of these studies, both scientifically and in practical terms, is undeniable. Very important in the prevention of diabetes mellitus, especially insulin-dependent diabetes, is the ability to identify individuals genetically predisposed to diabetes with these methods. Under conditions of low-intensity Lviv radioactivity, such a predisposition in the general population was 28.77%, which is 3.77% higher compared to the literature. The authors discovered pyruvic diabetes syndrome, the frequency of which in the general population is 8.90% (the compensation phase is 6.16%, the decompensation phase is 2.74%).The monograph consists of a brief introduction and 7 sections (chapters), the literary index contains 124 sources. A presentation of the methodology for conducting the above tests is preceded by Section 2, in which the authors evaluate the role of the pyruvate dehydrogenase system of mitochondria and the Measles cycle in the mechanism of regulation of carbohydrate metabolism.A relatively simple biochemical method for the determination of pyruvate in urine and blood under conditions of a carbohydrate load provides very valuable information that allows for early diagnosis of diabetes. The authors also identify options for the borderline states of glucose tolerance: insufficiency of the early phase of insulin secretion, pyruvate dehydrogenase hyper- and hypotolerance, contra -insulin deficiency (relative hyperinsulinism), etc.

A short course on Diabetology, attended by 83 doctors was evaluated. The doctors were divided into three groups. (Group I--basic qualification MBBS, Group II--MD in medicine or allied subject, Group III--Diploma in Diabetes Mellitus). The mean age group of all three groups were comparable. Pre-course evaluation of their knowledge of diabetes showed the best performance in Group III and poorest in Group I. Post-course evaluation showed significant improvement only in Group I and II. Maximal improvement in performance was seen in Group II. Mean time since passing the last professional examination was 14.8, 12.6 and 1.0 year respectively. The performance was not linked to time since passing the last examination. 14.5% of doctors were from a rural or semiurban setting. The precourse performance of rural doctors in the MD group was significantly poorer, but their post course performance was as good as the others. All doctors from rural or semiurban areas improved their performance postcourse, compared to 84% in the urban group. 74% of doctors had not attended any post graduate course after their basic degree. Their performance did not differ significantly from those who had attended such courses. 44.6% were Consultants, 26.6% were general practitioners, 12.0% were attached to institutions, 10.8% were in government service or armed forces and 6% were attached to teaching hospitals. The performance of the doctors was not linked to the type of practice. The doctors attending the course felt that the audiovisual presentation needed improvement.

The development of overweight has recently been recognized as a common finding especially in adolecents with IDDM. However, both normal longitudinal growth and the prevention of overweight are major goals in pediatric diabetology. We therefore investigated, how genetic factors contribute to this undesirable event. At the time of diagnosis, children with type-I liabetes are lean and slightly taller than average (SD-scores: height: +0.51 ± 0.07; weight: +0.33±0.06; BMI: + 0.08±0.05; n = 251, mean±SE). However, after > 10 years, a significant portion of the patients loose height and become overweight: (height: -0.16±0.08; weight; + 0.77±0.09, BMI: +1.10 ± 0.1; n = 87). In a subgroup of 156 patients (74 boys, 82 girls, mean age 13.5 years), height and weight of both parents was measured at our institution. Height-SDS was +0.21 ± 0.09 tor fathers and +0.22 ±0.08 for mothers. The correlation between midparental height and height-SDS in the patients (+ 0.19 ±0.08) was highly significant (r=0.41, p< 0.0001). In contrast, patients with IDDM were considerably more overweight (SD-score: +0.83±0.01) compared to their parents (+ 0.28±0.1 for fathers and +0.41 ±0.1 for mothers), and weight correlated only weakly between parents and IDDM children (r=0.20, p

This 435-page, softcover book covers all of the major topics in diabetology, many in a succinct and abbreviated format. The text falls somewhere between a pocket manual and a full-sized hardcover textbook in length, scope, and size. It is physically a little too large to carry around in one's pocket, but not so small as to get lost on a bookshelf. Of major interest is that it was not written only for physicians. Paramedical personnel such as nurses, dietitians, psychologists, and especially diabetic educators would all benefit from having the book. Some of the best portions include the concise summaries at the end of each chapter, which can be perused rapidly when the clinical need arises. Numerous up-to-date references are also listed at the end of each chapter. One entire chapter is devoted to patient education, an often neglected or too abbreviated subject even in much larger texts. The same

The passing of Dr. Arnold Lazarow on June 26 was a loss to the science of diabetology. Dr. Lazarow, Professor and Chairman of the Department of Anatomy, University of Minnesota School of Medicine, Minneapolis, was Codirector of the Twelfth Research Symposium of the American Diabetes Association and Chairman of one of the three sessions. As a tribute to him, the Association herewith presents a summary of the Symposium.

Pumps with insulin are utilized to assure a supply of this hormone which is continuous but is adjusted to the varying need3 of those patients with diabetes mellitus who are insulin-dependent and difficult to treat by conventional or so-called optimal injections of insulin. Such insulin infusions constitute the most recent therapeutic acquisition of diabetology; they assure a minimal insulin supply, around 1 unit per hour, without interruption throughout the night arid are adaptable as a function of the fluctuations in blood sugar associated with meals, physical exercise, and also the unpredictabilities of the unstable forms of the disease. Adjustments for fast or slow delivery are made by the patient.

Pancreatic polypeptide (PP) is a 36 amino-acid residue peptide which has recently been recognised in pancreatic endocrine cells. Although PP has a number of effects on gastrointestinal and pancreatic exocrine function, its physiological function has not been clarified. Studies were undertaken to elucidate four aspects of the physiology and pathophysiology of this candidate hormone. Firstly, factors affecting the release of human PP (hPP) were assessed in healthy subjects; secondly polyacrylamide gel electrophoresis was used to investigate molecular heterogeneity of the peptide; thirdly, the organ uptake and half-life time of endogenous PP was measured in pigs; and finally, basal and stimulated serum hPP concentrations were assayed in patients with acute pancreatitis, chronic pancreatitis and maturity-onset diabetes mellitus.

The principles of health service organization in Croatia have become known and recognized worldwide, especially in developing countries, and are accepted by the WHO as "Croatian Model"...

Management of diabetic pregnancy is one of the areas of diabetology where the benefits of modern diabetes treatment are most clearly seen (Freinkel et al. 1985). Since the Second World War perinatal mortality in the Western World has decreased from around 30%–40% to a few per cent, at least in large specialized centres with centralization of control of the diabetic pregnancy (Pedersen 1977; Freinkel et al. 1985).

Ever since the demonstration of high prevalence of hypertension in diabetics by Hitzenberger in 1921 [1], hypertension has been recognized as a major complication of diabetes. However, for a long time, it had remained the Cinderella of diabetology. Only recently, the mechanisms involved in the genesis of hypertension have been studied, its influence on progression of nephropathy has been recognized, and the necessity of rigorous blood pressure control both prior to renal failure and in advanced renal failure has been widely appreciated.

The aim of this thesis is to investigate different methods of improving the glycaemic control of diabetic out-patients, within the scope of the author's training both as a therapeutic dietitian and as a teacher. Evidence is presented from the literature, which indicates that high-carbohydrate, high-fibre diets are of benefit in diabetes, that supplements of viscous fibre improve glycaemic control, and that education of the diabetic patient may help to achieve good diabetic control, provided that the patient also complies with all parameters of therapy. Three main studies have been undertaken: - (1) An educational project, to investigate the effect of a mass-education programme on compliance and control in diabetic out-patients. (2) An investigation of the effect of long-term high-fibre diets in diabetic out-patients. (3) A study of the use of guar gum in the diabetic diet. In Study 1, a large random sample of patients attending a diabetes outpatient clinic were tested by means of a detailed questionnaire, in order to assess their existing knowledge of the disease. A suitable education programme was then devised and patients were exposed to this in the clinic situation. Another sample of patients was then re-tested with the same questionnaire and statistical analysis was used to assess the effect of this programme on knowledge, compliance and control. Results indicate that, while patients' knowledge scores improved, there was no improvement in dietary compliance and also no significant change in the standard of diabetic control in the clinic population. In Study 2 we investigated the practical aspects of administering a high-fibre diet to diabetic out-patients in Cape Town, in the light of the reported benefits of diets containing large amounts of dietary fibre (OF) in the control of diabetes. Readily-available, low-cost foodstuffs with a high OF content, were incorporated into suitable, individualised high-fibre meal plans for 10 selected diabetic out-patients. Patients were closely monitored over a period of 9 months, for 3 months of which the high-fibre diet was prescribed. Various parameters of glycaemic control were recorded and analysed, and the patients' compliance to the new regimen was assessed. Only 3 patients approached the projected fibre intake, but significant negative correlations were found between the dietary fibre increments and both mean plasma glucose and mean serum triglyceride changes. These findings suggest that, were it not for poor dietary compliance, a high-fibre diet might result in significant improvement in diabetic control, and that education and motivation are of prime importance when making major changes to patients' eating habits. Study 3 investigates the use of guar gum, when incorporated into the diabetic diet in both short- and medium-term studies. This viscous fibre has been shown by workers overseas to be effective in lowering postprandial glycaemia. In this study a palatable vehicle for the gum, a digestive-type biscuit, was tested for its effect on glycaemic control when incorporated into the usual meal plans of diabetic out-patients, and also against an oral glucose load as a reference standard. It was found to be effective in reducing the post-prandial rise in blood glucose, and in improving glycaemic control, as shown by reduced fasting blood glucose values and decreased 24-hour urinary glucose excretion. The biscuit proved to be palatable and acceptable to patients, and the guar gum was effective in much smaller quantities than have previously been tested. It may therefore prove a valuable adjunct to diabetes therapy. Results of these studies indicate that compliance to therapeutic recommendations is the crux of achieving good diabetic control. Increased diabetic knowledge alone does not lead to improved diabetic control, and compliance to altered eating habits is difficult to achieve unless prior education and motivation has taken place. The simplest means of achieving better glycaemic control of diabetes appears to be the use of a supplement of viscous fibre, which will improve the glycaemic response to the patients' usual meals.

The development of the artificial pancreas (AP) was an important contribution to modern diabetology. The practical and theoretical findings obtained by its application in type I diabetic patients gave rise to new forms of treatment, i.e., portable insulin pumps and intensified conventional insulin therapy. Although these therapies lead to better results than conventional insulin administration, there is no doubt that the problems of diabetes therapy can be solved only by an implantable AP or pancreas transplantation.

The paper describes department of diabetology and its principles of functioning.

Maturity-onset diabetes of the young 1 (MODY1) is a monogenic diabetes condition caused by heterozygous HNF4A mutations. We investigate how HNF4A haploinsufficiency from a MODY1/HNF4A mutation influences the development of foregut-derived liver and pancreatic cells through differentiation of human induced pluripotent stem cells from a MODY1 family down the foregut lineage. In MODY1-derived hepatopancreatic progenitors, which expressed reduced HNF4A levels and mislocalized HNF4A, foregut genes were downregulated, whereas hindgut-specifying HOX genes were upregulated. MODY1-derived hepatocyte-like cells were found to exhibit altered morphology. Hepatic and β cell gene signatures were also perturbed in MODY1-derived hepatocyte-like and β-like cells, respectively. As mutant HNF4A (p.Ile271fs) did not undergo complete nonsense-mediated decay or exert dominant negativity, HNF4A-mediated loss of function is likely due to impaired transcriptional activation of target genes. Our results suggest that in MODY1, liver and pancreas development is perturbed early on, contributing to altered hepatic proteins and β cell defects in patients.

In recent years, there has been a clear trend towards an increase in the prevalence of diabetes mellitus, and therefore the number of patients in need of emergency care is increasing.

Therapy in diabetes is rapidly advancing, and the practitioner is often left behind in his efforts to keep up with the latest advances. Thus, a new, comprehensive textbook of diabetology is always welcome, especially when it contains the wealth of information found in Davidson's book. The volume is particularly strong in several areas. Most noteworthy are the numerous tables and exhibits, which make up large portions of many chapters. These serve as useful guides to the management of important therapeutic problems in diabetes and can easily serve as checklists for patient management. As such, students (medical, nursing, and dietetic) and residents will find them most helpful and efficient. Another valuable aspect of this book is its recognition that diabetes rarely occurs as an isolated finding. A major section covers concomitant problems such as hypertension, anesthesia, and family planning, while another welldone section considers the socioeconomic problems of diabetes. Most clinicians

Patient centred care (PCC) is a healthcare model which is sensitive towards the patients’ preferences, needs and values. Interest in the use of PCC in diabetology has heightened recently. There is a special need of the usage of PCC in Muslim communities. Six out of the ten countries with the highest prevalence of diabetes are Muslim majority countries. There are several religious and sociocultural issues specific to South Asian Muslim societies that merit the need of individualization of care for people with diabetes. Several such issues are presented in this article, along with recommendations for tackling them.

Background Presentation of results of diabetes prevention studies as relative risk reductions and the use of diagnostic categories instead of metabolic parameters leads to overestimation of effects on diabetes risk. This survey examines to what extent overestimation of diabetes prevention is related to overestimation of prevention of late complications. Methods Participants of two postgraduate courses in clinical diabetology in Austria (n = 69) and Germany (n = 31) were presented a questionnaire with 8 items at the beginning of the meetings. All 100 questionnaires were returned with 92 filled in completely. Participants were asked 1) to rate the importance of differently framed results of prevention studies and, for comparison, of the United Kingdom Prospective Diabetes Study (UKPDS), 2) to estimate to what extent late complications could be prevented by the achieved reductions in diabetes risk or HbA1c values, respectively. Results Prevention of diabetes by 60% was considered important by 84% of participants and 35% thought that complications could be prevented by ≥ 55%. However, if corresponding HbA1c values were presented (6.0% versus 6.1%) only 19% rated this effect important, and 12% thought that late complications could be prevented by ≥ 55%. The difference in HbA1c of 0.9% over 10 years in the UKPDS was considered important by 75% of participants and 16% thought that complications ('any diabetes related endpoint') were reduced by ≥ 55% (correct answer Conclusion The novel key message of this study is that the misleading reporting of diabetes prevention studies results in overestimation of effects on late complications.

Patient-centred system of care is essential in managing many disorders such as diabetes mellitus. The cultural and religious context can influence the involvement of patients and their families in such a care. We intend to discuss patient-centred care in diabetology in view of Islam. For more clarification, we will take into consideration a few illustrative lines of argument in detail about situation in Iran. In conclusion, dynamic spirit of Islamic jurisprudence is reflected in its adaptability to change in medical practice. In recent decades, Iranian religious scholars have provided scientists in new fields of science and research with appropriate directions and guidelines. Decree issued by Iranian religious leaders permitting research on stem cells for therapeutic purposes in many disorders including diabetes mellitus is one example. Understanding of the nature of Islam is importance for communication with patients in Islamic countries.